Long-term treatment of somatostatin analog-refractory growth hormone-secreting pituitary tumors with pegvisomant alone or combined with long-acting somatostatin analogs: A retrospective analysis of clinical practice and outcomes

Background: pegvisomant (pegv) is widely used,alone or with somatostatin analogs (ssa),for gh-secreting pituitary tumors poorly controlled by ssas alone. no information is available on specific indications for or relative efficacies of pegv?+?ssa versus pegv monotherapy. aim of our study was to characterize real-life clinical use of pegv vs. pegv?+?ssa for ssa-resistant acromegaly (patient selection,long-term outcomes,adverse event rates,doses required to achieve control). methods. a retrospective analysis of data collected in 2005-2010 in five hospital-based endocrinology centers in rome was performed. sixty-two adult acromegaly patients treated ≥6 months with pegv (group 1,n?=?35) or pegv?+?ssa (group 2,n?=?27) after unsuccessful maximal-dose ssa monotherapy (≥12 months) were enroled. groups were compared in terms of clinical/biochemical characteristics at diagnosis and before pegv or pegv?+?ssa was started (baseline) and end-of-follow-up outcomes (igf-i levels,adverse event rates,final pegv doses). results: group 2 showed higher igf-i and gh levels and sleep apnea rates,higher rates residual tumor tissue at baseline,more substantial responses to ssa monotherapy and worse outcomes (igf-i normalization rates,final igf-i levels). tumor growth and hepatotoxicity events were rare in both groups. final daily pegv doses were similar and significantly increased with treatment duration in both groups. conclusions: pegv and pegv?+?ssa are safe,effective solutions for managing ssa-refractory acromegaly. pegv?+?ssa tends to be used for more aggressive disease associated with detectable tumor tissue. with both regimens,ongoing monitoring of responses is important since pegv doses needed to maintain igf-i control are likely to increase over time. © 2013 bianchi et al.; licensee biomed central ltd.